Role of antibiotic prophylaxis in open inguinal hernioplasty ? A prospective randomized clinical trial

Background: Inguinal hernia surgery is the most commonly performed surgery worldwide. Lichtenstein tension free repair using polypropylene mesh is the gold standard procedure for inguinal hernioplasty. Wound infection is the most common complication encountered in any surgical procedure. Antibiotic prophylaxis for open inguinal hernioplasty in minimizing wound infection has been a subject of debate since the beginning of mesh repair. We have conducted a randomized clinical trial in our hospital to analyze the usefulness of antibiotics in open inguinal hernioplasty. Material and methods: 60 patients were included in this prospective randomized control trial. 30 of them received 1 g of Injection Cefataxim half an hour before surgery and remaining 30 received injection Multivitamin infusion. Lichtenstein tension free hernia repair using polypropylene mesh was done. Superficial SSI was diagnosed according to CDC criteria. Results: Totally 5 patients developed SSI (8.33%). Out of the five, 2 (6.67%) were in antibiotic group and remaining 3 (10%) were in placebo group (p = 0.64). Odd’s ratio was 0.6429 (CI=0.0995 to 4.1531). All 5 had only superficial SSI; there was no deep surgical site infection (SSI). 2 patients were managed with dressing alone and remaining 3 with antibiotics. After 2 weeks, 2 had wound gapping and at four weeks wound was normal in all patients. 2 out of 5 were above 60 years of age and no SSI occurred >30 years of age (p value = 0.59). Conclusion: Routine use of antibiotics is not necessary in all open inguinal hernioplasty. Antibiotics can be reserved only for patients who are in high risk of SSI. Regularizing the use of antibiotics will have a good cost benefit and decrease the emergence of drug resistant organisms.